Oak Grove High School | |
5198 Old Highway 11 Hattiesburg MS 39402-6222 | |
(601) 264-7232 | |
(601) 796-9437 |
Full Name | Oak Grove High School |
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Speciality | Clinic/Center |
Location | 5198 Old Highway 11, Hattiesburg, Mississippi |
Authorized Official Name and Position | Kaye Ray (CEO) |
Authorized Official Contact | 6015458700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Oak Grove High School Po Box 1729 Hattiesburg MS 39403-1729 Ph: (601) 545-8700 | Oak Grove High School 5198 Old Highway 11 Hattiesburg MS 39402-6222 Ph: (601) 264-7232 |
NPI Number | 1790359966 |
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Provider Enumeration Date | 05/13/2021 |
Last Update Date | 09/06/2022 |
Medicare PECOS PAC ID | 2466342605 |
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Medicare Enrollment ID | O20220930003016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790359966 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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